ARCHIVED – Therapy for Autism
ARCHIVED: Please note, whilst every effort has been made to update blog posts, this blog post has been archived and may present outdated and incorrect information and terminology.
For the past 7 years I have been overly indulged in therapy, so much so that at one point it felt like a full time job. When people ask me where I am going at the same time every week, I no longer whisper that I’m just off to another hospital appointment; I would have apparently rather people think I had an awful disease or was going to pick up my methadone for my drug addiction than that once or twice a week I went and sat in a room with a nice cup of tea (that’s a lie, I don’t drink tea, but in theory if I did I would be), and talk for an hour about ‘stuff’. During these 7 years I have learnt one very important thing: therapy is only good if it’s the right kind of therapy. This seems like stating the obvious but for someone with Autism or Aspergers, it is vitally important. People with autism or Asperger syndrome are particularly vulnerable to mental health problems (65%) such as anxiety and depression, especially in late adolescence and early adult life (Tantam & Prestwood, 1999). Before being diagnosed with Aspergers I had a series of hilariously bad and just downright damaging therapists/counsellors. All of which completely missed my Aspergers, and between them created a whole list of mental and personality problems before dumping me in the ‘cannot be cured, won’t be cured’ pile.
My first taste of therapy came at the tender age of 16, and came in the shape of a small wiry middle-aged cognitive behavioural therapist who was allergic to radiators, and insisted I join the local Buddhist Centre;
“I just don’t understand why this is necessary. You’ve been like this your whole life and you’ve never needed to have therapy before!” my mum exclaimed, her voice had risen to a pitch only detectable to dogs and very young children.
“Well maybe if I had been taken before I wouldn’t need it so much now! Besides, the doctor thinks I really need help and these people can give me extra support.” I threw back at her.
“Support for what?!”
“I don’t know, but apparently I need it and they can give it so I’m going, and you are coming with me in case they try to lock me up!” One week later we were both sat in a young people’s mental health clinic. My mum sat defiantly on the edge of her brightly coloured worn chair, coat still firmly done up. Before even meeting me my therapist had already blamed all my problems on my mother and warned her to stay away from the therapy room (given my mum’s current defensiveness I could sort of see where that assumption had come from). Half an hour later I legged it out of that room and into the waiting area. I found my mum perched even further off her chair, car keys in hand.
“She’s allergic to radiators, we need to leave fast”. I attempted to whisper at her to avoid grabbing the attention of the other patients and receptionist. Without having to tell my mum twice she quickly followed behind me and out of the bright purple coloured doors.
“I don’t think I really need to see a therapist after all.” I told mum in the car.
“No, one sessions probably enough.” She replied as we scooted out of the car park and headed back home.
My second experience of C
ognitive Behavioural Therapy (CBT) came in a much friendlier package, and a woman I got on with incredibly well. However, looks can be deceiving and because my Aspergers was unknown, this therapist turned out to be more destructive than beneficial. CBT is basically used to address negative thought patterns, and uses practical techniques to conquer your fears, it’s pretty simple stuff and often effective, providing you’re able to identify your thoughts and verbalise them in the first place. She would often shout at me exasperated “but WHY does that make you feel anxious!?” over and over as I gradually become more and more mute, until finally after 8 sessions relenting and declaring me ‘stuck’, with an ‘avoidant personally disorder’, which is basically Psychologies way of telling you that you are screwed, and can’t be helped. The problem was that we were both looking at ‘common causes’ of anxiety, but actually mine weren’t that specific. One day going to the supermarket wouldn’t even flicker an ounce of anxiety, the next it would cripple me. This was because it wasn’t the supermarket which made me anxious, it was other uncontrollable factors; the lighting, weather, temperature, smells, how much sleep I’d had, who I’d bumped into, what else I had done that day, if I had a list, how busy it was, was my mind on other things…the list is endless.
For someone who has difficulty recognising and talking about their feelings, and who approaches the task with the rigor of a scientist trying to find the genetic code for the bubonic plague, counselling and talking type therapies have always been somewhat of a challenge. My mouth caves in and answers with a generic “yes everything fine thanks, can’t complain!” even when I’ve had a car crash of a week and have retired to my bed for the fore
seeable future. You see, as part of growing up and trying to adapt to living in the ‘normal’ world of polite conversation, I have learnt to avoid all possible faux pas’ with a strict list of polite replies and automatic panic attacks if the conversation delves into anything more personal. Queue an introduction to my third counsellor, a hardened, rough, middle-aged northern man who looked and sounded like he had come straight from the mines. In fact, he was an ex-train mechanic who after suffering from several panic attacks had turned his hand to counselling university students. With our shared avoidance of displaying emotions, in any other situation I feel we would have got along swimmingly, however I had turned to him after the failure and abandonment of my last therapist, was suffering from severe anxiety, and could not make head nor tail of what was happening in my head. On one occasion he sat me down and told me to close my eyes, then proceeded in his strong, gravelly, northern accent to create a relaxing scene of me on a beach, where the waves are “lappin’ at ya feet”. He then proceeded to have a massive smokers coughing fit and aborted our imaginary holiday, and I thanked God for small mercies and for sending the North of England a particularly virulent strain of the common cold that winter. We ended our sessions when I finally realised the only advice he had given me in several months was to count cars if I’m outside and having a panic attack, and listen to a Paul McKenna CD when I’m inside having a panic attack, covering every possible eventuality, brilliant had either of those techniques worked.
Several counsellors, one’s advice to 
start Belly Dancing and another’s to write angry letters, later, and I came to the long overdue conclusion that I was talking-therapy-impaired. I had all but given up hope of ever being able to sort out my ‘head issues’ when I was given the opportunity to start Art Therapy. I could now draw my emotions. Yes, emotions didn’t have to be spoken, they could be drawn, created, symbolised, she’d know what I meant without me having to say anything! Pretty early on in my sessions my art therapist spotted that I had a lot of Autistic traits, she had never seen someone so generally anxious and I wasn’t responding like a standard patient with anxiety and depression would, my thinking was very different and it took me a long time to form a relationship with her which could even start to have some therapeutic benefits. Short term therapy is just no good for someone with Aspergers, our heads take a little longer to process the information and recover from it, and even a slight wrong turn can take us back to square one. Now my therapy is adapted to suit me, art is one of my special interests to start with, I can send emails when I’ve found it too difficult to verbally say what I am thinking, I can have time out when it’s getting too much, talk about every thought I’ve had that week that I haven’t understood and get a new perspective, or just sit in silence for an hour whilst planning my to-do list and what to have for tea! What I am trying to get at in this long self-indulgent memoir of my therapy experiences (yes I know, you’re thanking God you’re not my therapist) is that there is a right type of therapy for people with Aspergers, and that is therapy which acknowledges the individuals’ differences and can adapt to them, as Howlin (1997) says, “it is crucial that the physician involved is fully informed about the individuals usual style of communication, both verbal and non-verbal”. Hare and Paine (1997) list ways in which the therapy can be adapted for use with people with Asperger syndrome:
- Having a clear structure
- Adapting the length of sessions
- The therapy must be non-interpretative
- The therapy must not be anxiety provoking as any arousal of emotion during therapy may be very counterproductive
- Group therapy should not be used
- It is also important that the therapist has a working knowledge and understanding of Aspergers syndrome in a counselling setting, i.e. the difficulty people have dealing things emotionally, finding it best to deal with things intellectually
- The therapist and client can work towards explicit operational goals, the focus being on concrete and specific symptoms
The final important factor to consider when providing therapy and treatments to those on the spectrum is that they are not labelled as having mental illnesses they do not possess. Common mental health problems such as anxiety and depression can often present themselves in atypical ways. For example, Tantam and Prestwood (1999) describe how for ‘someone with Autism the depression might show itself through an individuals’ particular preoccupations and obsessions and care must be taken to ensure that the depression is not diagnosed as schizophrenia or some other psychotic disorder or just put down to autism’. It is crucially important to acknowledge that therapy is not a treatment for Autism or even for the characteristics of Autism; it is useful for the mental health issues that arise as a result of having the disorder and for adapting to life with it. It is now as much a necessity for maintaining my overall wellbeing as spending the beginning of the week watching the washing machine go round.
More info:
http://autism.about.com/od/autismtherapy101/a/psychautism.htm
http://www.autism.org.uk/working-with/health/mental-health-and-asperger-syndrome.aspx
http://www.goodtherapy.org/therapy-for-aspergers-autism.html
Dr Hannah Louise Belcher 